Let’s start with the money because without it there’s nothing more to say: I had a face-lift eight years ago because my Uncle Mike refused to spend money on quality care for himself in the last years of his life.

He bought cheap TV dinners and went without a new hearing aid to leave a legacy to his nephew and nieces. I spent one-third of the money on something I could live without.

Or could I?

In truth, I needed the gift of that surgery – the self-confidence and self-esteem of looking younger. And I needed the benediction that a breast cancer four years earlier was not going to kill me.

My reasoning was fairly common, says Dr. Loren Eskenazi, founding partner of a three-woman plastic surgery practice in San Francisco and author, with Peg Streep, of the new book “More Than Skin Deep: Exploring the Real Reasons Why Women Go Under the Knife” (HarperCollins).

“I just had a patient 10 years post-cancer who had no breasts but wanted a face-lift because she said she looked so old relative to parents of her kids’ friends and, she said, ‘I’m 10 years alive and I want to celebrate that,’ ” Eskenazi said.

After performing about 10,000 reconstructive and elective procedures over the past 25 years, she says there are myths and misconceptions about cosmetic surgery. Eskenazi says the desire for transformation through surgery is connected to psychological and spiritual change, what she calls a chosen rite of passage to have outer selves reflect an inner reality.

Q:Plastic surgery is still condemned, if you will, as vain and superficial.

A:I believe surgery – all surgery – can be very spiritual. At key points in our lives, something changes internally, there is psychological shifting and we want to mark that time, like a tattoo.

The whole process of surgery is so ritualistic – like an initiation rite in culture. We fast; we enter the temple (the operating room). We take off our outer garments, lie down on the altar and undergo a death/reverse-death sequence. We lose consciousness. We wake up transformed with a mark or a blood ritual of some sort.

You know, we mimic this in the Communion in Christian religions when we eat the body of Christ. This ritual is innate to the human species.

Q:This is very deep, doctor.

A:Well, you see it every day in plastic surgery. Healthy people walk in of their own volition. There’s a reason you walk in that particular day. There’s a mystery to the whole thing.

Q:But aren’t we talking about an anti-aging procedure?

A:What I’m proposing is not anti-aging. Are we against the fact we are aging? No. But we are in a culture where we don’t value the outer manifestations of aging. We don’t value the wisdom of aging.

Q:In your book, which is short yet very insightful, you suggest women consider several questions before going under the knife. Questions like, Why did you decide on surgery now? What do you hope to gain from this surgery?

A: I believe it is important for women to understand their reasoning. You cannot use this surgery as a substitute for dealing with other pressing issues in your life.

People who undertake this surgery should understand, OK, this is serious business but I am willing to take it on. I have turned away women who are not clear on why they want this surgery.

Q:Isn’t this surgery addictive for some women?

A: Yes, it can be addictive. For some women, it is a way to distract them from what is really going on in their lives.

Q:There has been an astronomical rise in plastic surgery and other enhancement treatments. Why?

A:I believe part of it is connected to our sense of isolation from extended family and community. We don’t have a cultural context for a big life transitions – such as your breast cancer and its impact on your life and your thinking. People are alone, not witnessed, seen and held by the community during these difficult times.

And so we want to stay connected to the community we have.

Q:Have you had plastic surgery? Do you consider yourself liberated or addicted to beauty?

A:I’m a feminist and a plastic surgery patient.

Q:What about Botox and other facial enhancement treatments that don’t require surgery?

A: Botox and the rest are a warm-up – putting your foot in the water. Needle or knife? Once you make the first step, the others are a lot easier.

Q:How do you define the women who have plastic surgery? Are they addicted to beauty?

A: Some people won’t do anything, not even color their hair. But, look, there are 15 million women who had surgery last year. Are they all narcissistic, mentally ill lemmings running into the water? No, they are intelligent women with advance degrees, self-made women and most of them are very happy.

There are surgeries that will alter the appearance forever, so much so that the person is rendered, in a real sense, no longer recognizable as herself. This is clearly not a trend any one of us would recognize as healthy or desirable.

By contrast, consciously realized surgeries seek to integrate the self, body and spirit.

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